PROJECT SUMMARY/ABSTRACT
Autistic Children are at 160 times greater risk of drowning than the general pediatric population. Though swim
instruction is recommended as a drowning prevention strategy, there is extremely limited research evaluating
swim instruction for autistic children and no comparative trials. We developed Sensory Enhanced Aquatics
(SEA), a swimming and water-safety program specifically to accommodate autistic children’s unique
challenges and learning needs. Program evaluation data showed SEA improved children’s swim skills, with
74% improving at least one swim level (n=40) and 100% of parents feeling safer with their child around water.
Thus, we propose to conduct a single blind, randomized controlled pilot trial to test the differential effects of an
eight-week (16 lesson) SEA intervention and standard swim lessons on attainment of swimming and water-
safety skills of autistic children. We will enroll 50 autistic children aged 5-9 years who will be randomized 1:1 by
minimization to either the SEA intervention or standard swim lessons to minimize imbalanced group allocation
by autism severity and baseline swim skill. Aim 1 will compare the effects of SEA to standard swimming
lessons on swimming and water safety skills of autistic children with a swim test based on Red Cross water-
competency guidelines. Aim 2 will assess which participant characteristics (e.g., age, motor ability, autism
severity) are associated with the highest post-intervention swim skills and water safety across both groups to
inform who benefits most from swim instruction. Child sex and co-occurring motor impairment will be
considered as potential covariates. Data will be collected before swim lessons and after 8 weeks of SEA or
standard lessons. We hypothesize children in both groups will demonstrate improvement in swimming and
water safety skills with greater improvements in the SEA group; autism severity and motor ability will have the
greatest associations with swim skill in both groups. Our exploratory aim will employ post-intervention semi-
structured interviews to explore child, parent, and instructor perspectives about instructional methods most
effective for developing swimming and water-safety among autistic children. The information obtained from this
study will improve our understanding of the best strategies for swim instruction for autistic children and support
our long-term goal to make SEA scalable on the national level to prevent drowning of autistic children.
